Finding 380606 (2022-001)

Significant Deficiency
Requirement
N
Questioned Costs
-
Year
2022
Accepted
2024-03-15
Audit: 295375
Organization: Bassett Healthcare Network (NY)
Auditor: Kpmg LLP

AI Summary

  • Core Issue: Bassett Healthcare Network did not request approval for the disengagement of a key person involved in a Federal award.
  • Impacted Requirements: This violates 45 CFR 75.303(a) and 2 CFR 200.308 regarding internal controls and prior approval for personnel changes.
  • Recommended Follow-Up: Improve internal controls to ensure timely requests for approval on key personnel changes and retain necessary documentation.

Finding Text

Criteria Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, section 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the nonfederal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Furthermore, Title 2 U.S. Code of Federal Regulations Part 200 (2 CFR 200.308), Revision of budget and program plans, specifies that recipients of Federal awards must request prior approvals from Federal awarding agencies for 1) Change in a key person specified in the application or the Federal award, and 2) The disengagement from the project for more than three months, or a 25 percent reduction in time devoted to the project, by the approved project director or principal investigator. Condition Bassett Healthcare Network (the Network) failed to properly request approval for the disengagement of a key person specified in the Federal award application. Cause The condition found is due to lack of timeliness in communication regarding the disengagement of key personnel to the Network who are is responsible for requesting Federal awarding agency approval as well as not retaining key documentation. Possible Asserted Effect Failure to identify changes in or disengagement of key personnel and, therefore, failure to request approval from the appropriate Federal awarding agency. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding This is not a repeat finding. Recommendation We recommend the Network enhance the precision level and effectiveness of its internal controls related to the identification of changes to key personnel to ensure proper approval is requested timely. Further, we recommend the implementation of retention Views of Responsible Officials Recommendation accepted. Corrective action in progress. Reference the corrective action plan for further details.

Corrective Action Plan

We agree with the finding and observations and specifically note the following corrective actions will be implemented: - Develop policies and procedures to review employees’ timesheets charging federal grant and ensure changes in key personnel are identified timely - Monitoring of sub-recipient key personnel to identify discrepancies in a timely manner and take corrective action, with clear support documentation and retention - Training sessions for personnel assigned to manage the program and retain the records and succession. Responsible Official(s): * Director, Research/NYCAMH & Office of Sponsored Programs * Vice President of Financial Operations

Categories

Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Other Findings in this Audit

  • 957048 2022-001
    Significant Deficiency

Programs in Audit

ALN Program Name Expenditures
93.498 Provider Relief Fund $552,842
93.247 Advanced Nursing Education Grant Program $386,224
93.262 Occupational Safety and Health Program $300,172
93.359 Nurse Education, Practice Quality and Retention Grants $274,992
93.525 State Planning and Establishment Grants for the Affordable Care Act (aca)õs Exchanges $266,501
93.104 Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (sed) $129,727
93.301 Small Rural Hospital Improvement Grant Program $84,317
93.994 Maternal and Child Health Services Block Grant to the States $51,077
93.889 National Bioterrorism Hospital Preparedness Program $40,000
93.074 Hospital Preparedness Program (hpp) and Public Health Emergency Preparedness (phep) Aligned Cooperative Agreements $40,000
93.387 National and State Tobacco Control Program (b) $19,224
93.395 Cancer Treatment Research $18,881
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $9,055